Deltoid Ligament Repair

1. Exposure

1. An incision was made over the medial gutter of the ankle.
2. Dissection was carried down to find the anterior fibers of the deltoid ligament.
3. Careful dissection was performed and great care was taken to protect the saphenous nerve and vein.
   • It was clear from the arthroscopy that had been done previously that the anterior fibers of the deltoid had been avulsed off the anterior portion of the medial malleolus.

2. Debridement

1. This area was further cleaned of fibrous tissue.

3. Examine for Instability

1. The ankle was put through a range of motion to test for stability and demonstrate laxity of the incompetent ligament.

4. Rasp and Irrigate

1. A rasp was used to prepare the bone prior to drilling, and the resulting debris was irrigated out of the wound.

5. Repair Ligament

1. Drill holes were made, and a suture anchor was placed.
2. The sutures were then passed through the proximal portion of the anterior fibers of the deltoid ligament, and these were tied down to their origin.

6. Test Repair

1. The ankle was put through a range of motion to test for stability and ensure that the repair remained intact under stress.

7. Closure

1. After this had been done, the wound was thoroughly irrigated and closed in a layered fashion.